Table supported surgical retractor



D. P. SMITH TABLE SUPPORTED SURGICAL RETRACTOR Feb. 19, 1952 3Sheets-Sheet 1 Filed May 11, 1949 INVENTOR. Dnvm R SM/TH d l r9.

HTTORNEY Feb. 19, 1952 D. P. SMITH 2, 8 8

TABLE SUPPORTED SURGICAL RETRACTOR Filed May 11, 1949 3 Sheets-Sheet 2INVENTOR. DH V/D R SM/ TH BY i 9 W Fl TTORNE Y Feb. 19, 1952 D. P. SMITH2,586,488

TABLE SUPPORTED SURGICAL. RETRACTOR Filed May 11, 1949 3 Sheets-Sheet 3INVENTOR. DHV/D P 'SM/ TH TTORNEY Patented Feb. 19, 1952 ITE'D STATE SPATE N T O F F 1 :CE

TABLE SUPPORTED SURGICAL RETRACTOR David P. Smith, Meriden, "Conn.

Application Mayll, 1949, Serial No. 92,602

6 Claims. 1

This invention relates to surgical ,retractors. and more p rticularly toan abdominal retractor which has a plurality of independently adjustableretracting elements for holding the edges of a wound and the viscera orother organs away from the field of an operation.

One object of this invention is to provide a device of the above naturein which the retracting elements are adapted to be secured in fixedpositions with relation to the .operating table or other surface uponwhich the patient rests, thus avoiding movement of the retractingelements which would shock the patient or which would be a source ofannoyance to the surgeon.

Another object .is to provide a device of the above nature which may beemployed to retract any part ,of the wound or the organs therein in onedirection without requiring a retraction of another part in an oppositedirection.

Another object is to provide a device of the above nature in which thepositions of one or more of the retracting elements may be changedwhenever desired during the course of an operation without disturbingthe adjustment of the other retracting elements.

Another object is to provide a device of the above nature which may bereadily applied, adjusted, and removed, and which will not be likely toaccidentally change its adjustment, whereby the retractor will require aminimum of attention from the operating surgeon, and a minimum number ofassistants will be required.

A further object is to provide a device of the above nature whichwill besimple in construction, inexpensive to manufacture, easy to install andmanipulate, veryeflicient and durable in use, and

which will greatly facilitate the 'work of the surgeon.

With these and other objects in view, there have been illustrated on theaccompanying drawing several forms in which the invention mayconveniently be embodied in practice.

In the drawings,

Fig. 1 is an end view of one form of the improved retractor as it wouldappear when applied to an operating table, the patients body beingindicated in broken lines.

Fig. 2 :is a plan view of the same.

Fig. 3 is a perspective view, on an enlarged scale, partly in section,taken on the line 3-3 of Fig .2, showing one of the retracting elementssecured in the supporting ring.

Fig. 4 is a fragmentary sectional .view, taken approximately upon theline 4-.4 of Fig. v2, showing how one side of the supporting ring .isattached to one of the side bars.

4 the line 1 1 of 'Fig. 6, an angularly adjusted position of theretracting element being shown in broken lines.

Fig. 8 is an end view, partly in-section of a.

modification of the invention, showing a con-' cave-convex supportingring which is adapted to conform approximately to the shape of thepatients abdomen.

Figs. 9 and 10 are plan views of 'another'modified form of the inventionin which two independently mounted half rings are provided for securingthe retracting elements.

Fig. 11 is a partial plan view of another modification of the inventionin which a slotted ring is adapted to support retracting elements bymeans of chains.

Fig. 12 is a cross sectional view of a portion of the same on anenlarged scale, taken on the line -12l2 of Fig. 11.

Fig. 1'3 is an end view similar to Fig. l, 'but showing how the firstform of retractor may be mounted upon an auxiliary trough upon which thepatient rests.

Referring now to the drawings in which like reference numerals denotecorresponding parts throughout the several views, the improved.retractor comprises a, supporting ring l0 which is of flat circularshape, and which is provided with a symmetrical series of diametricallyopposed horizontal radial apertures ll of rectangular cross-section.

The supporting ring 10 is also provided with a. series of verticalcircular apertures 12 which intersect the radial apertures H, and whichare adapted to receive a plurality of angular locking pins I3.

In order to support the ring l0, provision is made of a pair ofhorizontally extending side arms M, 15, which are adapted to enter adiametrically opposed .pair of the horizontal apertures H, and whicharms are apertured adjacent their inner ends for the reception of a pairof the locking pins 13, whereby the ring l0 may be securely anddetachably fastened to said side arms.

The side arms M, l5 are bent downwardly at their outer ends'so as toform vertical lower por- .tions .20, .2! which are adapted to be securedto an operating table I6 of the type which has side tracting elements36.

adjustment vertically and longitudinally of the operating table IS. Theclamps 22, 23 are provided with thumb screws 25, whereby the side arms[4, l may be firmly clamped to the side rails IT, IS.

In order to hold the wound open and retain the internal organs of thebody away from the field of operation of the surgeon, provision is madeof a plurality of bendable retracting elements 25 which are adapted tobe shaped manually as desired, and which are provided with elongatedrigid upper horizontal base portions 26 adapted to selectively enter anyof the radial apertures H of the ring 10.

Each of the base portions 26 is provided with a longitudinal row ofapertures 21, whereby the locking pins 13 may be employed to lock theretracting elements 25 in any of a plurality of longitudinally adjustedpositions within the radial apertures l i.

A modified type of retracting element 27a which may be supported by thering I8 is shown in Fig. 5,

and comprises an upper horizontal base portion 28 having adownwardly-extending T-shaped arm 29 which i adapted to engage and holdthe wound or the organs therein. The base portion 28 is adapted to beinserted in any of the radial apertures ll of the ring 10 and isprovided with a longitudinal row of apertures 38, whereby said baseportion may be locked in different adjusted positions by means of one ofthe locking pins l3.

If desired, provision may be made of a modified concavo-convex form ofsupporting ring 3| (Fig. 8) which is provided with horizontal edgeportions 32 having radial apertures ll adapted to receive the side arms[4, i5. 3! may be shaped to conform closely to the curvature of thepatients abdomen when it is supported with its concave side downwardlyas shown, while in other cases it may be applied in an invertedposition, in accordance with the various conditions which may arise.

In Figs. 6 and '7 another modified supporting ring 33 is shown which issimilar to the ring (8, but which is also provided with a plurality ofradially-extending cylindrical apertures or bores 34 adapted to slidablyand rotatably receive elongated cylindrical base portions 35 of bendablere- In order to adjustably secure the retracting elements 36 in the ring33, provision is made of knurled set screws 31 which are adapted to beengaged in a plurality of vertical tapped aperture 38, intersecting theradial apertures 34.

Under some circumstances it may be desirable to support the retractingelements at different levels, as for example in performing operationsclosely adjacent the chest, in which some of the retracting elements maynecessarily be held above the chest while others, in order to beeffective, must be held at a lower level, adjacent a sagging abdomen. Insuch circumstances the surgeon may make use or" a pair of half rings 39,40 (Figs. 9 and 10) which are supported respectively by the side arms[4, I5 and by a corresponding pair of side arms M, 42. It will beunderstood that The supporting ring 1.

additional clamps 22, 23 will be provided for holding the side arms 4|,42 upon the side rails l1, [8.

Each of the half rings 39, 40 extends slightly more than degrees so thata pair of the radial apertures II will be diametrically opposed and willthus permit said half rings 39, All to be secured to the side arms l4,l5, and M, 42, respectively. In other respects, the half rings 39, 40may be identical to the supporting ring Ill, and will, in efiect,provide a single supporting ring, the different halves of which may besupported at different levels.

Fig. 11 shows a modified supporting ring 43 which is similar to thesupporting ring H! with the further provision of a narrow,outwardlyextending upper flange M which has a series of radial slots i5disposed around the periphery of said ring. A modified rake retractor46, is adapted to be adjustably secured to the supporting ring 43 bymeans of a chain M which is of the ball and link type and which may bepassed over the top surface of the ring 43, and then engaged in one ofthe slots 45 where it will be held by tension exerted by the retractingelement 53.

In the event that it is desired to employ the improved surgicalretractor in connection with an o erating table 48 which lacks siderails (Fig. 13), provision may be made of a trough 49 upon which thepatient P will lie and which is provided with a pair of side rails 55,5| to which the clamps 22, 23 will be applied for supporting the sidearms l4, l5.

Manner of use In use, the retractor herein disclosed will be applied tothe operating table 16 after the patient P has first been prepared forthe operation and is resting on said table in the position indicated inFig. l. The first step in applying the retractor will be to insert theside arms l4, 15 in the clamps 22, 23, which embrace the rails [7, l8,after which the upper ends of said side arms will be sprung apart so asto permit them to be inserted in an opposed pair of the radial aperturesll of the supporting ring 18, where they will be secured by means of apair of the locking pins 13. The insertion of the side arms [4, 15 willbe facilitated by having a certain degree of looseness in the clamps 22,23, inasmuch as the thumbscrews 24 preferably will not be tighteneduntil the supporting ring I 0 has been placed in the position which itwill occupy during the operation. The supporting ring ID will not restupon the patient but will be supported entirely by the side arms l4, 15.It will be understood that, if desired, the

side arms M, iii may be supplied in various horizontal lengths, wherebythe supporting ring H1 may be mounted in eccentric positions withrespect to the table l6.

After an incision has been made in the patients body, the retractingelements 25 will be inserted in the ring ID as desired, and secured bylocking pins I l. Inasmuch as the retracting elements 25 are providedwith a plurality of apertures 27, said retracting elements may besecured in vari ous positions in order to afford the desired support tothe organs or to the edges of the open wound.

It will be understood that the retracting elements 25 may be inserted,removed, or adjusted at any time during the course of the operation, andif desired, may be bent or replaced with retracting elements which arelonger or shorter, or of a different type, so as to suit the needs ofthe moment.

porting ring; 10 (Figs. 1 nds), with theexceptign that said half-rings-wi=llbe independently supported by -the-pa-irs ofside arms l4, l5, "and4|, 42, respectively, and thus may be independently adjusted withrespect to the operating table IS.

The modified supporting rings 3!, 33 and 43 (Figs. 6, '7, 8, and 11) maybe mounted upon the operating table l6 by means of the side arms l4, 15in the same manner as described above in connection with the supportingring 10. The ring 3|, however, will be employed for holding: the desiredretracting elements more closely adjacent concave or convex portions ofthe patients body, whereas the supporting ring 33 will permit theretracting elements 36 to be adjusted not onlylongitudinally, but alsoin an angular direction, as indicated in broken lines in Fig. 7.

The supporting ring 43 (Fig. 11) may be employed for holding theretracting elements 25 and 28, and is also adapted to support retractingelements such as the rake retractor 46 which will be adjustably securedby drawing the chain 41 over the upper surface of the ring 43, and thendownwardly so that said chain will enter and be held at the desiredpoint in one of the slots 45.

If the surgeon should be called upon to perform an operation when theonly available operating table 48 lacks side rails, he will place uponsaid table a trough 49 having side rails 50, 5!, to which he will attachthe side arms [4, l5 by means of the clamps 22, 23.

It will be noted that the invention herein disclosed provides a meanswhereby each of the retracting elements may be independently adjustedand held in a definite fixed position with-relation to the operatingtable l6, or to the trough 49 upon which the patient lies.

Thus, the retracting elements cannot accidentally change their position,and the force exerted by one retracting element will be independent ofthe force exerted by any of the other retracting elements. Consequently,the patient will be spared the shocks which are caused by accidentalmovements of retractors in contact with the peritoneum.

One advantage of the invention herein disclosed is that in most cases itwill enable the surgeon to perform an operation with the aid of only oneassistant, inasmuch as manually held retractors will be unnecessary.

While there have been disclosed in thisspecification several forms inwhich the invention may be embodied, it is to be understood that theseforms are shown for the purpose of illustration only, and that theinvention is not to be limited to the specific disclosures, but may bemodified and embodied in various other forms without departing from itsspirit. In short, the invention includes all the modifications andembodiments coming within the scope of the following claims.

Having thus fully described the invention, what is claimed as new, andfor which it is desired to secure Letters Patent, is:

1. In a surgical retractor, a supporting ring,

means on said ring for mounting said ring" upon an operating table, aplurality of retracting elements, and means adjustably attaching saidretracting elements to said ring in positions extending inwardly jromsaid ring, said ringmounting means comprising side arms secured inopposite rad-ial'a-pertures providing in said inasaids de arms avingvert al po i s pr vided with clamps for adiu ifibl securing said arms toa support, said .ver ticalportions being vertically slidable inapertures in said clamps and rele'asably held by screws said clamps.

'f;2. In a surgical retractor, a supporting ring, means on said ring formounting said ring upon an operating table, a plurality of retractingelements, and means adjustably attaching said retracting elements tosaid ring in positions ex tending inwardly from said ring, saidattaching means for said retracting elements comprising a plurality ofradial apertures in said ring, said retracting elements having baseportions adapted to be secured in said radial apertures by locking pinsentered through vertical apertures in said supporting ring and said baseportions said ring mounting means comprising a pair of angular membershaving horizontal arms adjustably secured in opposite radial aperturesof said ring and vertical side arms provided with clamps for attachingto the sides of said table.

3. In a surgical retractor, a supporting ring, means on said ring formounting said ring upon an operating table, a plurality of retractingelements, and means adjustably attachin said retracting elements to saidring in positions extending inwardly from said ring, said attachingmeans for said retracting elements comprising a plurality of radialapertures in said ring, said retracting elements having base portionsadapted to be secured in said radial apertures by set screws engaged intapped vertical apertures in said supporting ring and engaging said baseportions said ring mounting means comprising a pair of angular membershaving horizontal arms adjustably secured in opposite radial aperturesof said ring and vertical side arms provided with clamps for attachingto the sides of said table.

4. In a surgical retractor, a supporting ring, means on said ring formounting said ring upon an operating table, a plurality of retractingelements, and means adjustably attaching said retracting elements tosaid ring in positions extending inwardly from said ring, said attachingmeans for said retracting elements comprising an outwardly-extendingslotted peripheral flange on said ring, said retracting elements havingchains adapted to be engaged in slots in said flange.

5. The invention as defined in claim 1, including a trough adapted tosupport the patient, and provided with opposite side rails, said clampsbeing attached to said side rails.

6. In a surgical retractor, a supporting ring having a plurality ofradial apertures, a plurality of retracting elements engaged in some ofsaid apertures, a pair of side arms engaged in a diametrically opposedpair of said apertures, means securing said retracting elements and saidside arms in said apertures, said side arms comprising vertical endportions adapted to overlap a pair of opposite side rails upon anoperating table, a pair of clamps having intersecting horizontal andvertical channels loosely embracing said vertical side arm portions andadapted to embrace said rails, and set screws in said clamps forclamping said rails and said vertical end portions together.

DAVID P. SMITH.

(References on following page) REFERENCES CITED Number Name Date VanMeter May 9, 1893 Crossley June 26, 1917 Number 8 Name Date Morris May17, 1921 McCrory et a1 Dec. 20, 1921 Langworthy May 18. 1926 Stein Jan.4, 1927 Straus Feb. 18, 1930 Kraus Jan. 11, 1949 Rozek Jan. 3, 1950

